Brain Diseases in the Courtroom: Addiction and Insanity at the Intersection of Medicine and Criminal Justice

Abstract

Purpose: Among the many frontlines of the opioid epidemic, the courtroom is both underrepresented in popular media and outsize in its importance. People struggling with opioid addiction continue to interact with the criminal justice system at disproportionate rates, complicating efforts to render addiction a disease, not a crime. In this essay, I seek to illuminate the tensions between medicine and criminal justice with respect to addiction and insanity, another category of non-normative human behavior with a rich history of medicalization. Methods: I analyze two trials as case studies: the recent trial of Commonwealth vs. Eldred, in which Julie Eldred unsuccessfully argued that her detainment for violating her probation’s drug-free condition was an unconstitutional punishment for a symptom of her chronic brain disease of addiction, and the 1881 trial of Charles Guiteau, in which Guiteau’s defense unsuccessfully argued that the brain disease of insanity exonerated him from legal responsibility for the murder of President James Garfield. Results and Conclusions: Both trials involved remarkably parallel conflicts. On one side, self-consciously progressive voices advanced paradoxically deterministic models of human behavior. On the other, socially conservative interests argued for voluntaristic models that paradoxically justified severe restrictions on human autonomy. The similarities between the two trials may reflect certain intrinsic aspects of the tension between medicine and criminal justice. I conclude with an appraisal of important points of divergence between the two trials, which help reveal the unique status of addiction as a partially and complicatedly medicalized condition.